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General NPI Number Information
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NPI Number | 1942120779
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Entity Type | Organization
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Legal Business Name | ALKHAWAM DENTAL LLC
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Dates
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Enumeration Date | 07/20/2026
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Last Update Date | 07/20/2026
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Provider Practice Location Address
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Address Line | 360 MAIN ST
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City | SOUTH AMBOY
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State | NJ
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Zip | 08879-1634
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Country | US
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Telephone | 732-721-1166
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Fax |
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Provider Business Mailing Address
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Address Line | 307 MAIN ST
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City | SOUTH AMBOY
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State | NJ
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Zip | 08879-1602
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Country | US
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Telephone | 201-723-0219
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. YAZAN AHMAD ALKHAWAM
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Credential | DDS
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Telephone | 201-723-0219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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